LIBRARY OF CONGRESS. 






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UNITED STATES OF AMERICA. 



WHAT TO DO FIRST, 



IN 



ACCIDENTS OR POISONING 



CHARLES W. DULLES, M. D., 



SURGICAL REGISTRAR TO THE HOSPITAL OF THE UNIVERSITY OF PENN- 
SYLVANIA; SURGEON TO THE OUT-DOOR DEPARTMENT OF THE 
PRESBYTERIAN HOSPITAL, IN PHILADELPHIA. 




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PHILADELPHIA: 
PRESLEY BLAKISTON, 

1012 WALNUT STREET. 
l88o. 



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Entered according to Act of Congress, in the year 1880, by 

PRESLEY BLAKISTON, 

In the Office of the Librarian of Congress, at Washington, D. C. 



PREFACE. 

Whoever has seen how invaluable, in the 
presence of an accident, is the man or woman 
with a cool head, a steady hand, and some knowl- 
edge of what is best to be done^ will not fail to 
appreciate the desirability of possessing these 
qualifications. To have them in an emergency, 
one must acquire them before it arises, and it is 
with the hope of aiding any who wish to prepare 
themselves for such demands upon their own 
resources that the following suggestions have been 
put together. They are not meant to be elabo- 
rate, but simple and practicable. They cannot 
take the place of calling a physician or surgeon, 
but may fill up with helpful action what might 
otherwise be a period of inaction and despair, 
before skilled assistance arrives. With this view 
I trust they may prove of some value to the 
public, to whom they are offered. 

220 South 40 th Street, Philadelphia, 
June 10th, 1880. 



WHAT TO DO FIRST, 

IN 

ACCIDENTS OR POISONING 



It will not be possible, in a work of the scope 
of this, to consider any accidents except such as 
are* of tolerably common occurrence. Those that 
we shall consider will be arranged under the fol- 
lowing heads: — 

CLASS I. OBSTRUCTIONS TO RESPIRATION. 

DROWNING. 

HANGING. 

CHOKING. 

SUFFOCATION WITH NOXIOUS GASES. 

CLASS II. FOREIGN BODIES IN THE NOSE OR 

EAR. 

CLASS III. FITS, OR SEIZURES, OF VARIOUS 

KINDS. 
FAINTING. 
HYSTERICS. 
EPILEPTIC FITS. 

CONVULSIONS FROM IRRITATIVE CAUSES. 
APOPLEXY. 
INTOXICATION.* 
STUNNING. 
CATALEPSY. 

*This is not a classification according to causes, but symptoms. 
B 



10 



WHAT TO DO FIRST, 



CLASS IV. EFFECTS OF EXTREME COLD AND 

HEAT. 
FREEZING. 

BURNS AND SCALDS. 
SUNSTROKE. 

CLASS V. INJURIES OF THE BONES AND JOINTS. 

SPRAINS. 

DISLOCATIONS. 

FRACTURES. 

CLASS VI. WOUNDS. 

CONTUSED WOUNDS. 
LACERATED WOUNDS. 
PUNCTURED WOUNDS. 
POISONED WOUNDS. 
INCISED WOUNDS. 
GUNSHOT WOUNDS. 

hemorrhage. (General.) 






hemorrhage. (Special.) 



CLASS VII. 



RAILROAD AND 
ACCIDENTS. 



r Nose. 
, Lungs, 
j Stomach. 
[ Internal. 

MACHINERY 



TRANSPORTATION OF INJURED PERSONS. 
CLASS VIII. POISONS. 






IN ACCIDENTS OR POISONING. \\ 

CLASS I. 

OBSTRUCTIONS TO RESPIRATION. 



DROWNING. 

Of drowning it may seem absurd to say that 
the first thing to be done is to remove the person 
exposed to it from the water ; yet I well remem- 
ber to have seen, some years ago, the revolting 
spectacle of a woman's body, fastened with a 
rope, floating in a river, and gazed at by hundreds 
of curious people. Upon inquiry, a policeman 
gravely informed me that no one dared take it 
out before the arrival of the Coroner. This is a 
mistake; any one who thinks there is a chance of 
resuscitation should remove from the water a 
person presumed to have been drowned, and at 
once set about the work. This can be best done 
by freeing the body from any clothing that binds 
the neck, chest, or waist, turning it over upon the 
face for a moment and thrusting a finger into the 
mouth and sweeping it round, to bring away any 



12 



WHAT TO DO FIRST, 



thing that may have gotten in or accumulated 
there. Then the body should be laid out flat on 
the back, with something a few inches high under 
the shoulders (anything will do, a folded blanket, 
or shawl, or coat, or a stick of wood), so as to 
cause the neck to be slretched out and the chin to 
be carried far from the chest. The tongue should 
now be drawn well forward out of the mouth (it 
must be held with a cloth or it will slip away), 




and the effort to secure artificial respiration begun. 
The simplest way to do this is for some one to 
place himself on his knees behind the head, seize 
both arms near the elbows and sweep them round 
horizontally, away from the body and over the 
head till they meet above it, when a good, strong 
pull must be made upon them, and kept up a few 



IN A CCIDENTS OR POISONING. 13 

seconds. This whole manoeuvre should last about 
three seconds. It effects an inspiration — fills 
the lungs with air, by drawing the ribs up and so 
enlarging the cavity of the chest. The second 
manoeuvre consists simply in returning the arms 
to their former position alongside the chest, and 
then making firm pressure against the lower ribs, 
so as to drive the air out of the chest and effect an 
act of expiration. This need occupy but a sec- 
ond of time. 




If this plan is regularly carried out it will make 
about sixteen complete acts of respiration in a 
minute. It should be kept up for a long time, 
and not abandoned until a competent person has 
ascertained that the heart has ceased to beat. The 
cessation of the pulse at the wrists amounts to 
nothing as a sign of death ; and often life is pre- 



14 WHA T TO DO FIRST, 

sent when only a most acute and practiced ear 
can detect the sound of the heart. 

It is important that the wet clothing shall be 
removed from a drowned person. This can always 
be done without interrupting the artificial respira- 
tion. If exposure must be avoided, something 
may be laid over the body (a coat, a shawl, a 
blanket, a sail), and the wet clothes loosened 
under it and drawn down over the feet. Then 
the body may be quickly slipped on to something 
dry, and covered with some other fabric, if the 
first has become wet, while this, in its turn, is 
pulled away from underneath. 

Warmth may be now secured by any means 
which ingenuity may suggest — hot bricks or stones, 
or even boards that have lain in the summer sun. 
At the seashore there is plenty of hot sand, and 
often plenty of baking bathing costumes. The 
body and limbs may be gently but constantly 
rubbed, to help the blood in its labored circula- 
tion. None of these things need interfere with 
the efforts to secure respiration, which must be 
uninterrupted. 

It is of advantage, if they can be gotten, to 
apply smelling salts to the nose, and to give some 



IN ACCIDENTS OR POISONING. 15 

stimulant as soon as it can be swallowed. There 
should be no pottering with teaspoonful doses, but 
a good tablespoonful of whisky or brandy be given 
every few minutes, till a teacupful has been used, 
or the danger point is passed. 

As natural respiration begins to be attempted, 
it should be aided as much as possible by timing 
the artificial to it. Little by little it will take the 
place of this, but must not be left un watched for 
some time. 

Only danger from cold or pressing necessity 
should permit the removal from one place 
to another of a person who is being resuscitated, 
before this has been thoroughly accomplished. 
When accomplished, however, the person should 
be put in a warm bed, being carried carefully, 
with the head low, and a watch kept to see that 
the breathing does not suddenly stop. 

HANGING. 

In regard to this a remark may be made which 
should be as needless as the first about drowning. 
In describing the quizzing of some medical stu- 
dents, Albert Smith makes Mr. Manhug reply to 
the question what he would do if called to a man 



16 WHAT TO DO FIRST, 

who had hanged himself? " Cut him down, sir." 
But I have heard, among others, of a case where the 
warden of a prison, discovering a convict who had 
hanged himself, instead of first following Mr. 
Manhug's humane plan of procedure, ran straight- 
way to tell his superior officer, and came back 
with him just too late to rescue the poor suicide.* 
The first duty to one strangled is to remove the 
instrument of strangulation, whatever it may be. 
After this artificial respiration must be instituted, 
as described above, and the warmth of the body 
kept up. 

STRANGLING. 

Strangling with the hand, or a cord, or anything 
that can be used for this purpose, should be treated 
the same way. 

CHOKING. 

Choking with foreign substances in the throat 

* More recently the following item was published in the Public Ledger, 
February 17th, 1880: — "An extraordinary incident, which would be 
absolutely incredible were not its truth amply vouched for, has just oc- 
curred at Marseilles. A man, living at L'Estaque, hanged himself at 
the door of his house, with a girdle of wool. A neighbor having given 
the alarm, a number of persons rushed up, but they never thought bi 
cutting the man down, and calmly watched him as he writhed in the 
death agony, which was very long. An officer of customs, who reached 
the spot a quarter of an hour after the crowd had begun to collect, re- 
leased the victim, but it was then too late ; he had ceased to breathe. 



IN A CCIDENTS OR POISONING. 17 

demands their removal as soon as possible. Crusts 
or bones may often be pulled out by one with a 
cool head and steady fingers. If not, of course, 
medical help is indispensable. Children not in- 
frequently get buttons, or coins, or marbles in 
their throats, and come near choking to death. 
Such things may be pulled out or expelled by 
vomiting, if this can be provoked ; if not, I do 
not care to repeat the common advice, to try to 
poke them down ; but think that responsibility 
may well be left for the surgeon. 

If pins get stuck in the mouth or throat, it is 
sometimes an extremely delicate matter to remove 
them. Sometimes, on the other hand, they may 
be grasped with the fingers or a pair of scissors — ■ 
used like forceps — and pulled out. If this cannot 
be done, the patient should be made to lie down, 
and kept as quiet as possible in body and mind, 
till some one comes who can give relief. * 

If foreign bodies get into the windpipe they will 
soon be coughed out, or require surgical skill for 
their removal. Moderate blows on the back, with 
the open hand, sometimes aid the coughing act. 

*The practice, by adults, of putting pins in the mouth is neither very- 
clean nor very safe, and is to be discountenanced, for both these reasons. 



18 WHAT TO DO FIRST, 

In any case where the breathing is not seriously 
interfered with, it will be most prudent for non- 
medical persons to keep " hands off." For there 
may no longer be anything in the throat, though 
it appears there is ; and it can do no good to make 
groping efforts to bring away foreign substances 
that have already gone down into the stomach, 
only leaving behind an irritation which deceives 
the patients and their friends. 

SUFFOCATION WITH NOXIOUS GASES 
AND VAPORS. 

This calls for instant removal to the fresh air, 
and the employment of artificial respiration, as 
described in speaking of Drowning, till the natural 
is re-established. 



IN A CCIDENTS OR POISONING. 19 

CLASS II. 

FOREIGN BODIES IN THE NOSE OR EAR. 



Children sometimes place, or have placed, in 
their noses or ears small bodies, such as peas, mar- 
bles, etc. If the nose be the part chosen the wisest 
plan is to try to expel the obstacle by blowing. 
If this does not soon succeed, reasonable efforts 
may be made to fish it out, with a hair-pin or some- 
thing of that sort; but these must not be too 
prolonged ; for, if a surgeon must be called, the 
sooner the better. The longer it is delayed, the 
harder will be his work and the worse for the 
child. The same is true of efforts to remove for- 
eign bodies from the ear. In case peas or beans 
are used in these sports, the danger is increased 
by the fact that if they absorb any moisture they 
swell up and are very difficult to get away. 

If insects get into the nose or ear, some sort of 
oil or glycerine should be poured in upon them. 
This will dislodge them better than anything else. 



20 WHA T TO DO FIRST, 

CLASS III. 

FITS, OR SEIZURES OF VARIOUS KINDS. 



FAINTING. 

Fainting is too familiar to need much detail of 
symptoms. It is due to a temporary weakening or 
pause in the heart's action, causing a diminution 
or suspension of the circulation of blood in the 
brain, and a consequent loss of consciousness. This 
is accompanied with a loss of muscular power, so 
that the individual, if standing, falls. The pallor 
of fainting is very well known, and is simply a signal 
of the like bloodlessness which obtains in the 
brain itself. Usually no treatment is demanded 
in fainting, for a wise provision of Nature puts the 
person who faints in the best position for recovery, 
that is, lying down. But if in anyway this is pre- 
vented from happening of itself, it should be 
brought about by a bystander. A fainting per- 
son must be laid out flat at once. The head must 
be put as low as, or lower than, the body, so that 
the heart may not have to work against the law of 



IN A CCIDENTS OR POISONING. 21 

gravitation in sending blood to the brain. 
Sprinkling water upon the face and holding smelling 
salts to the nose tend to excite the nerves of sen- 
sation, and rouse the brain and heart to renewed 
activity. So they are useful. Nothing else is 
necessary ; but of all, the first, the indispensable 
thing, is to lay the fainting person down flat. 
Nothing should be allowed to interfere with this. 

HYSTERICS. 

Hysterics — not hysteria, for that is usually a long 
and inscrutable nervous disease — but fits of hys- 
terics, marked by prolonged and uncontrollable 
laughing or crying, are best treated by the exercise 
of calmness and patience on the part of the 
bystanders, sometimes by taking no notice of the 
attack, or by leaving the unfortunate sufferer in a 
room by herself, or himself — for men are at times 
subject to this curious disorder. Heroic measures, 
like dashing water into the face, and so forth, are 
not to be generally recommended. 

EPILEPTIC FITS. 

In epileptic fits there is usually a pallor of the 
face, a peculiar cry, a loss of consciousness, and 
then violent convulsions. They are to be treated 



22 WHAT TO DO FIRST, 

very much like fainting fits, because in them also 
the brain is temporarily bloodless. At the same 
time any movements calculated to injure the person 
must be controlled. There is no use in struggling 
against such as will do no injury ; they had better 
be simply regulated, and no attempt made to entirely 
prevent them; but a folded towel or a piece of soft 
wood may be — if it can be — thrust between the 
teeth, to prevent the usual biting of the tongue. 
When the height of the convulsion is passed, rest, 
quiet, and perhaps a moderate stimulation may be 
secured. Here again the flat position of the body 
must be obtained. 

I remember, one summer, at the seashore, to 
have seen some ill-advised, though kind-hearted, 
persons walking a boy up and down the beach 
during an epileptic attack, because, from his pallid 
face, they thought he was suffering from the cold ; 
and they were much astonished at the rapidity 
with which he regained consciousness when laid 
out flat on the sand. 

CONVULSIONS. 

Convulsions from irritative causes, so common 
among children, call for a prompt emetic, and are 



IN A CCIDENTS OR POISONING. 23 

often much alleviated by applying cold to the 
head and placing the body in a very warm bath. 

APOPLEXY. 

Apoplexy consists of the rupture of a blood 
vessel in the brain, and is marked by a greater or 
less loss of consciousness, heavy, snoring breath- 
ing, and usually a deeply flushed face. 

For this, rest and cold to the head constitute 
the best treatment until medical advice, which is 
indispensable, can be obtained. 

INTOXICA TION. 

Intoxication sometimes closely resembles apo- 
plexy, and should be treated in the same way until 
its identity can be safely established, for which the 
odor of the breath is a useful guide. Then an 
emetic should be given, and if any hartshorn is at 
hand, a teaspoonful of this in a teacupful of water. 
A large draught of vinegar will often go a great 
way toward sobering an intoxicated person. But 
it must be borne in mind that if a mistake be made — 
as has been — and the trouble be an apoplexy, no 
more dangerous thing could be done than to give 
an emetic. 



24 WHAT TO DO FIRST, 

STUNNING. 

If unconsciousness has been caused by a blow 
upon the head, the best thing to do is to lay the 
patient out flat on the back, loosen any clothing 
that binds the neck or waist, and secure quiet and 
plenty of fresh air. If the skin becomes cold and 
clammy, heat should be applied to the feet and 
stomach. No whisky or brandy should be given, 
except by a doctor's order. 

CATALEPSY. 

Catalepsy is a very rare state, resembling death. 
It affords time enough for summoning a doctor, 
and this is the only sensible thing to do under 
these circumstances. 



IN ACCIDENTS OR POISONING. 25 

CLASS IV. 

EFFECTS OF EXTREME COLD AND HEAT. 



FREEZING. 

Freezing sometimes takes place in so insidious a 
way that the sufferer is not aware of it till great 
damage has been done. Toes are perhaps oftenest 
frozen or frost-bitten. This results from the practice 
of wearing tight and insufficient coverings on the 
feet. When it occurs, it is best treated by gradu- 
ally bringing the temperature up to that which is 
normal — about ioo° Fahrenheit — and maintaining 
it there. Warm baths, gentle friction, and afterward 
covering with a thick, hot poultice, is the best 
thing that can be done until medical help can be 
obtained. This is important in such cases, because 
not infrequently gangrene follows the freezing of 
the feet, making it necessary to amputate parts of 
them. Frozen fingers, ears, or noses are of less 
frequent occurrence, but must be treated on the 
same principles. 

If the whole body has been exposed to extreme 
c 



26 WHAT TO DO FIRST, 

cold, there will follow a depression which requires 

the most cautious treatment. To restore its 

warmth is the first demand, and for this a warm 

bath, made gradually warmer until as hot as can 

be well borne, or surrounding with heated blankets, 

or exposure before an open fire, may be used. At 

the same time stimulants may be given internally, 

such as hot tea or coffee, with the addition of 

spirits. 

BURNS OR SCALDS. 

These are usually dangerous in proportion to their 
extent and depth. Those which involve as much 
as half the surface of the skin are almost neces- 
sarily fatal. Their treatment may be divided 
under two heads. 

The first is for the moment of the accident. 
When clothes are on fire the wearer must not run 
about, but lie down and be covered with a rug, or 
carpet, or shawl, or coat — anything which will ex- 
clude the air and smother the flame. If, in fright, 
the sufferer lose presence of mind, some bystander 
must take the responsibility of throwing her (for 
these accidents usually happen to women, on 
account of the character of their clothing) down 
and enveloping her with some thick cover. 



IN A CCIDENTS OR POISONING. 27 

Afterward, the burned part must be disturbed as 
little as possible. It is customary in hospitals to 
clip away the clothing and envelope the patient in 
lint soaked in " Carron oil," a mixture of equal 
parts of linseed oil and lime water, and administer 
stimulants and anodynes. Since, however, I have 
never known a person severely and extensively 
burned to recover under this treatment, I venture 
to suggest the immersion of the entire body in a 
bath, which shall be kept as long as necessary 
(and this may be several days) at a temperature of 
ioo°, or more. At the same time some stimulant 
should be given, and laudanum, in twenty-drop 
doses to an adult, to allay the suffering. Of course, 
medical advice will be taken in such grave circum- 
stances. 

Lesser burns are best treated by applying a cloth 
soaked in a strong solution of baking soda — the 
bicarbonate. This usually allays the pain more 
effectually than anything else that is known. 
Carron oil is a good application for such burns. 
Anything may be used which will prevent friction 
and exclude the air ; but nothing should be used 
which will stick in cakes and prevent after-ex- 
amination, or make this very painful. Flour and 



28 WHAT TO DO FIRST, 

cotton batting, though often recommended, are 
subject to these drawbacks, and had better be 
avoided. For small burns simple cold water is 
better in every way than these. 

Burns with acids must be deluged with water 
and then treated in the same way; those with 
caustic alkalies by an application of vinegar. 

Lime sometimes gets into the eyes, and may 
there do great damage. It should be treated with 
free washing, deluging the eye, in fact, until all 
is washed away. A little vinegar may be added 
to the water, say a tablespoonful to the teacupful, 
at first. 

If acids or alkalies are swallowed they must be 

treated as described in speaking of poisons. (See 

Poisons.) 

SUNSTROKE. 

Sunstroke, or more properly heat stroke, is not 
even usually due to the direct rays of the sun, but 
to a prolonged elevation of the bodily temperature, 
oftenest while working, and especially in confined 
places. When it takes place in the open air it is 
apt to be on oppressive, heavy, or murky days. 
It is generally preceded for some time by pain in 
the head and a sense of oppression. The attack, 



IN A CCIDENTS OR POISONING. 29 

however, culminates in a loss of consciousness, 
with heavy, labored breathing, and an intense, 
burning, dry heat of the skin. The absence of 
perspiration in the presence of so great heat is one 
of the most characteristic symptoms of heat stroke. 

When it occurs the thing to be done is to lower 
the temperature. As much of the clothing as pos- 
sible must be removed, cold must be applied to 
the head and body, and ice may be rubbed over 
the chest and placed in the armpits. 

Pouring cold water over the body is not to be 
advised, as it conveys a needless shock to the sys- 
tem ; but there is nothing better than to place the 
body in a cold bath, or to wrap it in sheets kept 
wet and cold by renewed applications of cold water 
or ice. After awhile consciousness will return. 
Then the cold may be discontinued, to be re- 
newed only if the surface becomes again very hot — 
that is, hot in contrast to that of a well person, not 
in contrast to the ice or water that has been used — 
or in case consciousness should be lost again. 

It must always be remembered that sunstroke, 
or heat stroke, is a very dangerous thing, and may 
be followed by very grave and permanent impair- 
ment of the intellect. 



30 WHA T TO DO FIRST, 

CLASS V. 

INJURIES OF THE BONES AND JOINTS. 



The most frequent injuries to the bones and 
joints are sprains, dislocations and fractures. 

SPRAINS. 

Sprains must be treated by rest, and heat or 
cold, as is best suited to each case. Sprains of the 
finger or wrist usually require cold and moist ap- 
plications. Sprains of the ankle should never be 
treated lightly. In them there is not infrequently 
a little fracture of the inner surface of one of the 
leg bones that form the ankle joint. This complica- 
tion gives rise to so much trouble, and requires 
such skillful and patient treatment, that it has come 
to be believed that it is better to have a broken 
leg than a sprained ankle. The general principle, 
however, in the case of a sprained ankle is, first 
to put the joint at complete rest, allay inflamma- 
tion, if it arises, and afterward promote the 
absorption of inflammatory products. For the 



IN ACCIDENTS OR POISONING. 31 

first a splint and bandage are usually necessary; 
for the second, friction, kneading of the joint, at 
times careful motion of it, and the use of moist 
heat. But in few cases is it truer that "he who 
doctors himself has a fool for a patient. ' ' 

DISLOCATIONS. 

These injuries consist of the displacement of the 
articular or joint end of a bone. They cannot 
occur (except when the same joint has been out of 
place before) without the tearing of ligaments 
whose function it is to keep the joint close. The 
simplest dislocations, those of fingers, can usually 
be reduced — or put in place — by strong pulling, 
aided by a little pressure upon the parts of the 
bones nearest the joint. Dislocations of the 
thumb are, even for surgeons, sometimes almost 
impossible to put in place. 

There is another dislocation which may be 
treated by almost any one. And this is fortunate, 
since it is very awkward, and very trying to the 
patient. It may occur at any time and under the 
most unexpected circumstances. Within a few 
years a clergyman of this city went to a hospital 
to visit a parishioner, and while passing through 



32 WHA T TO DO FIRST, 

a corridor, gave a tremendous gap. With a little 
snap the lower jaw bone slipped out of joint, 
leaving him unable to close his mouth ; of open- 
ing it wider there could be no question. In this 
unfortunate predicament the intended exhortation 
had to be postponed, and the services of the 
resident surgeon called for, to reduce the dislo- 
cation ; after which, with a face all bandaged up, 
the poor man went to his home, with a very vivid 
impression of what may come of a yawn. 

To reduce a dislocation of this sort, the sides 
of the jaw must be seized between the thumb and 
fingers of each hand, with the thumbs resting on 
the teeth and the fingers below the jaw, and firm 
pressure be made, first downward and then back- 
ward. It must be remembered to cover the thumbs 
with several thicknesses of cloth, and as soon as 
the jaw starts into place, to slip them off to the 
outer side of the teeth, inside the cheeks, or the 
releaser will be rewarded by having his thumbs 
mashed between the upper and nether millstones. 
He must be quick as lightning, too, for the 
muscles do not wait, when they have been so 
unnaturally on the stretch, but bring the lower 
teeth against the upper like a hammer. 



IN A CCIDENTS OR POISONING. 33 

There is still another form of dislocation of the 
jaw, in which this is just a little open and cannot 
be opened any wider or closed. The thing to do 
in such a case is to slip a strong spoon handle or 
table knife in between the teeth and pry the jaw 
wider open. This will make the bone slip back 
into its place. 

Dislocations of other joints ought not to be tam- 
pered with at all. The best that can be done is 
to put the parts in the position easiest to the suf- 
ferer, surround the joint with cold, wet cloths, 
and send for a surgeon. The risk of doing injury 
by injudicious efforts to set a joint is greater than 
that of waiting till a surgeon can be summoned. 

FRACTURES. 

Broken bones call for treatment as various as 
they themselves are. Most of them require special 
appliances known only to surgeons, and no attempt 
should be made by any one who has not surgical 
training to do more than treat a fracture tempo- 
rarily. However, until a surgeon can be gotten, 
the following suggestions may be adopted, as far 
as the circumstances will permit. In breaks of 
long bones, like those of the leg or arm, draw the 



34 WHAT TO DO FIRST, 

limb out a little, make it as straight as possible, 
(comparing it with its fellow of the opposite side) 
and place under it a pillow. Then pass broad band- 
ages around this, and tie them together over the 
limb, so as to draw the sides of the pillow pretty 
firmly up against it. This is simply for the pur- 




pose of keeping it still. Then cold, wet cloths 
should be frequently applied to the surface of the 
limb, so as to prevent, as far as possible, the swell- 
ing which usually comes on soon after a fracture, 
and which often interferes very much with the 
examination of the surgeon.* 

In fractures near any joint it is best to bend 

* There is nothing in which there is a greater call for ingenuity and 
fertility of resource than in extemporizing splints for broken bones. 
Pasteboard, leather, shingles, pieces of cigar box — anything fairly smooth 
and stiff, may be used. A surgeon at the seashore got himself no little 
credit once by setting a broken arm on the beach, folding up and using 
as a splint a large newspaper which he had been reading. When a leg is 
broken, the other one will make a good temporary splint. 



IN A CCIDENTS OR POISONING. 



35 



the joint a little, and lay the limb flat on a pillow, 
keeping it cool and moist. These breaks are 
especially grave, and demand the best skill that 
can be obtained. 

Fractures of bones that lie deep in the body, like 
the hip bone or the shoulder blade, are very hard 
to detect, and can be treated only by rest and 
coolness till a surgeon comes. 

The same may be said of fractures of the ribs, 
though one might put on 
the side of the chest, where 
the break is, long strips of 
sticking plaster, about an 
inch and a half wide, placed 
parallel to the ribs, begin- 
ning at the lowest part of 
the chest and going up, each strip being made to 
overlap the one below about half its width. The 
strips should extend from the spinal column to the 
middle of the breast bone. This makes the chest 
wall more rigid and prevents the rubbing together 
of the broken ends of the bone. 

In fractures of the collar-bone the patient should 
be laid on his back, on a hard, flat, hair mattress, 
or on a settee, with a folded blanket under him 




36 



WHAT TO DO FIRST, 



(never on feathers), without any pillow, and kept 

so until the surgeon comes. 

In fractures of the skull there is nothing the 

non-medical can do better than putting the patient 

at rest, lying down, and placing cold, wet cloths 

to the head. 

Fractures of the spinal colwnn (broken back) 

are very hard to detect, but if one be suspected 

the patient must be moved as little as possible. 

He had best be laid out 
upon his back, and, if pos- 
sible, not be disturbed till 
the surgeon directs it. Turn- 
ing such a patient over upon 
his face is dangerous, and 
must not be permitted. 

In fractures of the jaw, 
close the mouth and put a 
bandage round, so as to 

keep the two rows of teeth against each other. 




IN ACCIDENTS OR POISONING. 37 

CLASS VI. 

WOUNDS. 



In going over these we will adopt the classifica- 
tion customary in works on surgery, viz., contused, 
lacerated, punctured, poisoned, incised and gun- 
shot wounds. 

CONTUSED WOUNDS. 

Contused wounds are what are usually known 
as bruises, and almost all such as are caused by 
blows. They are sometimes very painful, and often 
followed by discoloration, due to the escape of 
blood under the skin from the small vessels of a 
part. A black eye is a familiar example of this 
sort of an injury. 

They are best treated at first, when painful, by 
the application of cold, wet cloths. Later, when 
the pain has subsided, hot, wet cloths are best, as 
they favor the carrying off of the blood that has 
escaped. 



38 WHAT TO DO FIRST, 

LACERATED WOUNDS. 

Lacerated wounds are tears, such as are often 
caused by machinery. These always require surgi- 
cal skill. Till it can be obtained, however, the 
torn parts can be placed in as nearly their natural 
position as possible (after removing, with a stream 
of cold water squeezed from a sponge, any foreign 
matters that can be so gotten rid of) and covered 
with a cool, wet cloth. If the tear has been very 
great, and the sufferer is depressed and cold, 
tablespoonful doses of brandy or whisky may be 
administered, and a cloth wrung out of hot water 
placed over the injured parts. 

PUNCTURED WOUNDS. 

Punctured wounds are made with sharp, pointed 
objects, like pins, needles, fish hooks, glass, thorns 
or splinters. 

Pin wounds rarely do much harm. 

If a needle is run into the flesh and comes out, 
always see that it is all there ; and if any part, 
from point to eye, is missing, call a surgeon. 
Meanwhile keep the wounded part perfectly still, 
and make no attempt to remove what remains. 
This would probably be quite in vain, and would 



IN A CCIDENTS OR POISONING. 39 

only increase the difficulty of the surgeon's work 
when he arrives. The broken needle should be 
carefully kept and shown to him, as he will then 
know better what to look for in his examination. 

A fish hook is a troublesome thing to get in one. 
If this should happen, the best thing to do would 
be to cut off the string, push the point of the hook 
through, and draw it out, like a needle in sewing. 
If it can be done, the broad part of the hook may 
be cut off before trying this. But this is not easy 
for the operator or the patient. 

Wounds from splinters of glass are quite beyond 
most people's skill. They are best treated with 
cold, wet applications, and left otherwise entirely 
to the surgeon. 

Thorns rarely do much harm unless they are 
poisonous, and wounds of this sort we shall con- 
sider later. 

Splinters are dangerous in proportion to their 
size and the part they enter. Small splinters may 
be picked out with a needle. Splinters under the 
nails are sometimes too hard for removal by the 
non-medical. Splinters in the eye should be 
pulled out, if possible. If not, the eyelid had 
better be gently closed, both eyes covered with a 



40 WHAT TO DO FIRST, 

layer of cotton soaked in cold water, and a band- 
age placed round the head, so as to keep the lids 
as still as possible. This bandage should not be 
too thick or put on too tight, and the application 
should be kept cold, with ice, if need be. 

If a large splinter enters the body, an attempt 
may be made to pull it out ; but a surgeon should 
be called without fail, and whatever of the splinter 
has been extracted carefully saved and shown 
to him. This will aid him in making up his 
mind whether the removal has been complete, 
and perhaps save much pain and danger to the 
patient. 

POISONED WOUNDS. 

Poisoned wounds may be considered here, as 
they are usually punctured, and result from the 
bites or stings of animals or insects. 

The wounds of ve?tomous serpents usually demand 
the prompt removal of the part bitten. It may 
be cut out instantly by any one who has the nerve 
to do it. Before this, perhaps, the part should be 
encircled, above the wound, with a tight ligature, 
and, if small enough, thrust into the mouth and 
sucked hard, so as to extract the poison. The 



IN ACCIDENTS OR POISONING. 41 

immediate application to the wound of hartshorn, 
is of advantage ; and a knitting-needle, or nail, 
heated to redness, may be thrust into it. At the 
same time, whisky should be given, in doses 
large enough to cause drunkenness, and the intoxi- 
cation kept up till medical aid can be secured. 

The stings of insects are rarely dangerous to life. 
They may be treated with cold, wet applications — 
wet earth is a very good one. 

The bites of cats are sometimes followed by 
severe inflammation ; but the first treatment should 
be simply cleansing the bites, sucking them, per- 
haps, and applying cold to them for a time. 

The bites of dogs are a terror to many people, 
while others have little fear and are very seldom 
bitten. Dogs seem to learn who do not fear 
them. If any one be bitten by a dog in good 
health, only the simplest treatment will be 
necessary. If the dog be sick, local inflammation, 
or severe constitutional disturbance may follow. 
In case of reasonable suspicion, the same course 
should be adopted as for bites of venomous snakes. 
Of course, too, sound medical advice will be taken. 

It is a foolish thing to kill a dog that has bitten 
anybody, soon after this has taken place. Such a 



42 WHA T TO DO FIRST, 

dog should be caught and kept under the observa- 
tion of some person of unquestioned carefulness, 
intelligence and special information. The too 
speedy slaughter of a dog has robbed many a 
sufferer of the assurance that would have been 
gained by seeing it living and well, and sent many 
a one to the grave, as dying of hydrophobia, who 
never had it, but had been bitten by a healthy 
and harmless animal. 

Again, if one has been bitten, and there be a 
reasonable suspicion that the dog was "mad," let 
him not despair. Some of the most able and care- 
ful (that is the greatest matter) medical men are 
of the opinion that a great many cases of so-called 
hydrophobia have been spurious ; that is, they were 
not hydrophobia at all. For myself, the more I 
have read on this subject the more convinced have 
I become that very few of the cases reported have 
really had hydrophobia ; but that the most have been 
alarmed by what they thought, and frightened by 
what injudicious friends or timid doctors have said 
and done, until they died of sheer terror. So, in 
case of a bite from a supposed mad dog, let the 
things suggested above be done ; then let quiet be 
secured, and the very best medical man in the place 



IN A CCIDENTS OK POISONING. 43 

sent for. It is a very serious matter, and calls for 
the clearest head and most extensive information. 
Whoever gets flurried and shows alarm at such 
times is scarcely less dangerous than the dog that 
did the biting. Then let no one breathe " hydro- 
phobia," or talk about what has happened. By 
this the chances of escape will be increased. 

This much is said, not to ventilate a theory, but 
with the belief that acting upon it will not increase 
the number of bites, while it may decrease the 
number of deaths from what is called " hydro- 
phobia. ' ' 

INCISED WOUNDS. 

Incised wounds or cuts, if simple and small, 
call only for a piece of sticking plaster, and per- 
haps a bandage. If large, the edges should be 
brought as near together as possible, and supported 
so by sticking plaster, or bandages, or the hands, 
till the coming of the surgeon. If an entire part 
be cut off, as an ear, or a nose, or a toe, or a finger, 
it should be cleaned with lukewarm water, and put 
in its place, leaving to the surgeon the decision 
whether it be worth while to try to save it. Some 
very remarkable cases of reunion of such parts are 



44 WHAT TO DO FIRST, 

on record, and an attempt to save them is not to 
be lightly rejected. 

Cuts of the walls of the abdomen are often 
followed by escape of a portion of the bowels. 
These, if dirty, should be cleansed, and a gentle 
effort made to restore them to their place. If this 
fails they should be covered with a clean white 
cloth, soaked in warm water and kept warm and 
wet by a gentle stream of water, or by laying on 
it a sponge soaked in warm water, which should 
be constantly renewed. 

There is a way to wash such delicate structures 
as the intestines, or raw cut or torn surfaces, which 
may be described here — and it is a good plan to 
learn to do such things by practicing them before 
the emergency arises. Dip a sponge in water, 
and hold it in the closed hand, with the thumb 
uppermost, and a corner of the sponge hanging 
below the fist. Now, on squeezing it regularly, a 
single stream of water will flow softly and steadily 
down from it. The size of this stream can be 
regulated by the way the sponge is squeezed \ the 
force by the height to which it is raised. This 
is the only way of cleaning off delicate tissues that 
is safe in the hands of the unexpert. 



IN A CCIDENTS OR POISONING. 45 

HEMORRHA GE. 

Many wounds are subject to a serious compli- 
cation, which we will now discuss. This compli- 
cation is hemorrhage or bleeding. 

Bleeding may come from the capillaries, the 
small vessels that intervene between the arteries 
and the veins, or from either of these latter. 

Capillary hemorrhage follows every cut. The 
color of the blood is bright red ; the flow is gener- 
ally slow and not very considerable. It usually 
stops of itself. If it does not, cold water or ice 
may be applied, or even vinegar. If there is oozing 
from a large raw surface, a towel may be folded, 
dipped in water as hot as the hand can bear, 
lightly squeezed, so as not to drip, and laid upon 
the bleeding surface. This may have to be re- 
newed once or twice, at intervals of a few minutes, 
but it usually acts like magic in this form of 
hemorrhage — the oozing. 

Hemorrhage from the veins is also generally 
slow and steady in its flow, the blood being of 
a darker color than in other forms. It, too, is 
rarely of consequence or demanding special effort 
to control it. When severe, the application of 



46 WHAT TO DO FIRST, 

cold, and firm continuous pressure upon and below 
the wound, generally suffice to stop it. 

Hemorrhage from the arteries is very dangerous. 
Here the blood is bright red, and spurts in a stream 
or leaps in jets from the divided vessel. If it be from 
a large artery, such as lie in the root of the neck 
or the armpit, or the inside of the thigh near the 
groin, life will usually be quickly lost. Indeed, 
without an acquaintance with anatomy, it is hardly 
likely that any advice that could be given here 
would be available in such cases. But every one 
may, while awaiting skilled aid, do something 
when the arteries of the limbs are cut. The first 
duty in all such cases is to be as cool as possible, 
then as quick as is consistent with coolness. The 
principle that must guide every attempt to stop 
the bleeding is to obstruct the artery between the 
centre of the body and where it is cut, for this is 
the direction in which the blood flows. 

For wounds of arteries of the hand, raising this 
above the head and making firm pressure with the 
thumbs, just above and in front of the wrist, will 
usually stop the bleeding. If this fails, and for 
Wounds below the elbow, first grasp the upper part 
of the arm with both hands and squeeze as hard 




IN A CCIDENTS OR POISONING. 47 

as possible ; then let some one make a thick, hard 
knot, as big as an egg, in the -middle of a hand- 
kerchief, place it over 
the middle of the front 
of the arm, immediately 
above the elbow, tie the 
ends tight at the back, 
and bend the forearm 
up so as to press hard 
against the knot. This , 
if successfully done, will obstruct the main blood 
vessel (the brachial artery), which in this place 
lies in the middle line of the bend of the elbow. 

For wounds in the upper arm, a knot as big 
as a fist may be made in any piece of cloth and 
shoved hard up into the armpit, and the elbow 
then brought straight down and held firmly against 
the side of the chest. 

If either of these methods fail, or cannot be 
carried out, the "Spanish-windlass" maybe used. 
To do this, place some hard, rounded body in the 
large part of a handkerchief folded diagonally, and 
carry the ends of this round the limb, so as to leave 
the lump over the position of the artery — that is, 
over the bend of the elbow, or a little in front of 



48 WHAT TO DO FIRST, 

the middle of the inside of the arm, near the 
shoulder. Then tie the ends of the handkerchief 
so as to make a loose loop, slip a stick through this 
and twist it round and round, so as to tighten the 
handkerchief, till the blood stops flowing. This is 
a much rougher procedure than the method de- 
scribed before, but one cannot be over-particular 
in such cases; so if the former fails, or no by- 
stander is cool enough to carry it out, no time must 
be lost before the "Spanish-windlass" is used. 

Wounds of arteries of the foot or leg may be 
treated by firm pressure in the hollow just behind 
the knee (above the calf of the leg). This can 
be effected by placing there a knotted cloth, like 
that suggested for the armpit, and doubling the leg 
back until it presses hard against it. 

For wounds in the thigh, pressure must be made 
in the hollow immediately below the groin, about 
two-thirds of the way from the hip bone to the 
middle line of the body, where the artery of the 
thigh (the femoral artery) comes out of the body. 
This can also be effected by placing there a big 
knot, and doubling the leg back on the thigh (this 
is important), and the thigh forward, hard against 
the abdomen. In case of failure of any of these 



IN A CCIDENTS OR POISONING. 49 

methods, the "Spanish-windlass" maybe used (as 
already described), so as to make pressure at the 
points indicated for each case. 

To go over this briefly again : Remember, first, to 
keep cool ; second, the principal object, to obstruct 
the blood vessel above the cut — and that this can 
be effected by a knot placed, in the several cases, 
in front of the bend of the elbow, in the armpit, 
behind the bend of the knee, or just below the 
groin, against which the nearest part of the limb 
is to be firmly pressed ; or, in case of failure, the 
"Spanish-windlass," applied to the same places.* 

In case none of the plans proposed can be car- 
ried out, a cut that bleeds profusely may be 
stuffed with a rag or dry earth, and this kept in 
place by pressure, or the cut part may be forcibly 
compressed in any way, or a finger thrust into 
the wound and held wherever it seems to do 
most good. 

* These suggestions are not imagined to be complete, nor do they 
cover every case that may arise ; but they are meant to be simple, rea- 
sonably easy to follow, and calculated to control the bleeding until a 
surgeon is at hand to put a permanent stop to it. I do not care to im- 
pair what I trust may be their usefulness by introducing further details, 
which might only confuse, without materially increasing the resources of 
one who may have to act in such a critical moment. 



50 WHAT TO DO FIRST, 

SPECIAL HEMORRHAGES. 

Bleeding from the nose is sometimes so profuse 
as to threaten life. If this be the case, of course 
medical aid will be summoned ; but until it ar- 
rives the best thing that can be done is to snuff 
vinegar up the nose, or plug the nostrils, from the 
front, with cotton thoroughly soaked in vinegar. A 
strong solution of alum in warm water is also use- 
ful ; but vinegar is less disagreeable, and will rarely 
fail, unless the case is beyond any except skilled 
help. 

In hemorrhage from the lungs the blood is bright 
red and generally frothy. It is rarely profuse, and 
yet as it is usually coughed up and caught in a 
handkerchief, it seems to be so. The amount 
can never be safely estimated in this way. The 
best treatment is rest in bed, with the body raised 
in the sitting posture, and the swallowing of lumps 
of ice. The application of cold to the chest, if 
the patient is not too weak, is of some use. 

In hemorrhage from the stomach the blood is 
usually very dark, looking like coffee grounds. 
If it is mixed with any other contents of the sto- 
mach, its appearance may be masked. In such 



IN A CCIDENTS OR POISONING. 

cases broken ice may be swallowed, and teaspoonful 
doses of vinegar. Rest in bed must, and the appli- 
cation of cold to the stomach may, be employed. 
In internal hemorrhage ice-cold cloths may be 
placed upon the abdomen. Rest in bed, without 
a pillow, and with the head lower than the body, 
must also be secured. 

GUNSHOT WOUNDS. 

There is another class of injuries occasionally 
met in civil life, though not common. These are 
gunshot wounds. Ordinarily little can be done for 
them, except by a surgeon ; and perhaps all that 
is advisable before he comes is to note and remem- 
ber the position of the body or the wounded part at 
the moment it was struck, and the direction from 
which the missile came, so that these facts may 
help the surgeon in his search for it.* Then cold 
wet cloths, upon which laudanum may be poured, 
should be kept upon the wound, to prevent, as far 
as possible, inflammatory swelling ; and if, as is 

* To show how strange may be the course of a bullet, I will cite a case 
that occurred in 1876. A young man was shot with a pistol. The ball 
passed through his lower lip, struck an upper front tooth, which it broke 
off, then glanced downward and backward, diagonally through the 
tongue, and finally buried itself in the floor of the mouth, on the other 
side from that'where it entered the lip. 



52 WHAT TO DO FIRST, 

very often the case, the patient be cold and de- 
pressed, a stimulating dose of wine, whisky or 
brandy should be given. If a part is badly 
shattered, the local treatment should be the same, 
except that, if there be much depression, cold had 
better not be used at all. There is rarely much 
bleeding from gunshot wounds, except when large 
vessels are divided. In such a case hemorrhage 
may be controlled as described under this head. 



IN ACCIDENTS OR POISONING. 53 



CLASS VII. 

RAILROAD AND MACHINERY ACCI 

DENTS. 



The injuries received in railroad and machinery 
accidents are usually of the classes described as 
Contused and Lacerated Wounds (see pages 37 
and 38), and only to a limited extent within the 
ability of the amateur surgeon. The best that 
can be done under the circumstances is to control 
any hemorrhage that may occur and combat the 
shock which almost always follows, by the judi- 
cious use of alcoholic stimulants. In case of great 
pain, cloths soaked in cool water, to which lauda- 
num (almost without limit) has been added, may 
be laid upon the injury for the time being. Then 
the injured part should be placed in a position as 
comfortable as possible, and the patient removed 
to a place suitable for subsequent treatment. 

TRANSPORTATION OF INJURED 
PERSONS. 

If injured persons have to be conveyed from 



54 WHA T TO DO FIRST, 

one place to another, it is worth while to know 
how to do it with the greatest ease and safety to 
them. If a door, or shutter, or settee is at hand, 
any of these will make a good litter, with a blanket, 
or shawls, or coats for pillows. If a limb is 
crushed or broken, it may be laid upon a pillow, 
with bandages tied round the whole so as to keep 
it from slipping about. (See page 34.) In case 
of an injury where lying down is not absolutely 
necessary, an injured person may be seated on a 
chair and carried, or he may sit upon a board or 
fence rail, the ends of which are carried by two 
men, around whose necks he should place his arms, 
so as to steady himself. When no litter can be 
gotten, the body may be supported by a man on 
each side, with their hands locked under the chest 
and hips. One careful person should support the 
head and another the injured limb, so that this 
may not be needlessly jarred or moved. 



IN ACCIDENTS OR POISONING. 00 

CLASS VIII. 

POISONS* 



Immediately upon the discovery or suspicion of 
poisoning, some one should be dispatched for a 
doctor, if possible, carrying information as to the 
poison taken, so that valuable time may be saved. 
Meanwhile the following may be done : 

I. If the Poison is not Known. — If the patient 
should vomit, this should be encouraged ; if not, 
it must be provoked. The simplest way to do 
this is to give large draughts of lukewarm water, 
and thrust a finger down the throat. If there be 
time, and it is at hand, a teaspoonful or two of 
ground mustard may be stirred up in the water, 
or a teaspoonful of powdered ipecac, or a table- 
spoonful of the syrup of ipecac. Further, let it 
be remembered that there is no occasion for 
fastidiousness. Any water will do. Water in 
which hands — or dishes, for that matter — have 
been washed, may, by its very repulsiveness, act 
more quickly than anything else ; and if soap has 

*The following is modified from an article originally published in 
Lippincott' s Magazine. 



56 WHA T TO DO FIRST, 

been used, it will be all the better for that, as soap 
is an antidote for acid poisons. The quantity used 
must be large ; the sufferer must be urged to drink 
and drink, a pint at a time, until he can contain 
no more, and has been made to vomit over and 
over again. 

After copious vomiting, soothing liquids should 
be given — oil, milk, beaten-up raw eggs — 
all in moderately large quantities. These are 
especially valuable when the poison has been of 
an irritating character. 

If the sufferer be much depressed in body or 
mind, the hands and feet cold, the lips blue, the 
face pale, a cold perspiration upon the forehead 
and about the mouth, then some stimulant may be 
administered. Strong, hot tea, without milk, is 
the best, because it is a chemical antidote to many 
poisons. Strong coffee is next in value. To 
either of these can be added brandy, whisky, wine, 
or alcohol, in tablespoonful doses for an adult, and 
half as much for a child ; or the spirits may be 
mixed with a little hot water. Warm coverings 
are not to be forgotten ; and if the depression be 
great, hot-water cans or hot bricks, wrapped in 
one or two thicknesses of blanket, should be laid 



IN ACCIDENTS OR POISONING. 57 

by the side of the chest, or a huge poultice placed 
round the body, or a blanket, wrung out of hot 
water and covered with a dry one. 

II . A cid Poisons. Oil of vitriol {sulphuric acid) 
and nitric and muriatic acids are heavy, sometimes 
yellowish-looking, fluids ; the first, as its name 
implies, not unlike oil in appearance, but very 
heavy in a bottle. The others are lighter, and 
give off extremely pungent, irritating fumes. All 
discolor anything on which they fall ; the first 
blackens pine wood, the others turn it yellow. All 
burn horribly, and leave no doubt of their caustic 
nature. 

For these the proper treatment is to give an 
alkali. A tablespoonful of hartshorn may be mixed 
with two teacupfuls of water, and given ; or almost 
unlimited quantities of soda, magnesia, lime, 
whitewash, chalk, tooth powder, whiting, plaster, 
soap or even wood ashes, stirred up in water. 

After this should come the provoking of vomit- 
ing ; then the bland fluids mentioned above should 
be administered, rest secured and stimulation em- 
ployed, if necessary. 

Oxalic acid comes in small, heavy, bright, color- 
less crystals, making a clear rattle in a bottle or jar. 



58 WHAT TO DO FIRST, 

For this the best antidote is lime in some form. 
If lime water is at hand, it may be given freely, 
or whitewash, tooth powder, chalk, whiting, or 
plaster from a wall. The latter may be crushed 
and stirred up in water, without regard to the 
grittiness, which will not do any harm. 

Carbolic acid is usually in solution, as a thick, 
clear or dusky fluid. When taken by the mouth 
it causes whitening and shriveling of the mucous 
membrane lining it, with intense burning and 
then numbness. There are also nausea, weakness 
and depression, sometimes actual collapse. It 
is a very dangerous poison, because it acts rapidly 
and benumbs the stomach, so that it is hard to 
provoke vomiting. This must be attempted, 
however, and large draughts of oil or milk given. 
Rest, warmth of the body and stimulation must 
also be secured 

III. Alkaline Poisons. — The strong alkalies are 
ammonia, or hartshorn — which is a clear fluid 
with an unmistakable odor — -potash and soda, 
usually dissolved, and sometimes in the form of 
lye. Liniments sometimes contain these sub- 
stances, and are swallowed by mistake. 

The alkalies usually burn intensely. They must 



IN A CCIDENTS OR POISONING. 59 

be combated with an acid. Vinegar can always 
be had, and there is nothing better. It should 
be given undiluted, and a pint at a time, if possible. 
Lemon juice may be used, or even orange juice, 
though the latter is too mild an acid to be of much 
service, unless the oranges are very sour. Vomit- 
ing should then be provoked, and followed by 
bland acid or oily drinks, rest and stimulation, 
if necessary. 

Arsenic, sugar of lead, corrosive sublimate and 
tartar emetic are not infrequently taken by mistake, 
because they are used for various household pur- 
poses. 

IV. Arsenic comes as a white, sweetish powder, 
often used to destroy domestic pests. It usually 
excites vomiting and violent pain in the stom- 
ach. The vomiting must be encouraged or pro- 
voked, and dialysed iron given. This can now be 
obtained at any drug store, and should be given 
freely, in tablespoonful doses, each dose being fol- 
lowed at once by a teaspoonful of common salt in 
a teacupful of water. Afterward vomiting should 
be again provoked, followed by a dose of castor oil. 

Paris green is an arsenical preparation. If taken 
as a poison, it must be treated like simple arsenic. 



60 WHAT TO DO FIRST, 

V. Sugar of lead comes in white lumps or 
powder, and calls for vomiting, Epsom salts, milk, 
eggs, and castor oil. 

VI. Corrosive sublimate comes in small, color- 
less crystals, or in a clear solution. If taken, 
vomiting must be provoked and some form of 
tannic acid given. Tea is the handiest thing 
containing this, and its administration should be 
followed up with eggs and milk. 

Tartar emetic, a white powder, is best treated 
in the same way. 

VII. Phosphorus is sometimes chewed off of 
matches, by children. It is a poison which acts 
slowly, and affords ample time for securing medi- 
cal advice. But five-grain doses of sulphate of 
copper, dissolved in water, may be given, at inter- 
vals of ten minutes, until vomiting comes on. 
Then a dose of magnesia should be administered ; 
but no oil. 

VIII. Opium Preparations. — These are opium, 
laudanum, paregoric, black drop, and the many 
poisonous nostrums sold as soothing-syrups, pain- 
destroyers, and drops for infants. Their symp- 
toms are deep sleep, with narrowing of the pupil 
of the eye to a small circle, which does tiot en- 



IN ACCIDENTS OR POISONING. 61 

large in the dark. Here emetics must be used 
promptly and persistently, and vomiting produced 
over and over again. Strong coffee must be freely 
given, as a stimulant. So long as the breathing 
does not fall below ten to the minute, there is no 
immediate danger of death ; but opium is a 
treacherous poison, and requires all the skill that 
can be obtained to combat it. The important 
matter is to keep up the breathing. The custom 
of walking a patient up and down and slapping 
him with wet towels is to be deprecated, because 
it adds exhaustion to stupor. If an electrical 
battery can be obtained, and used, it is the best 
thing that can be done. The next is to lay the 
patient upon a lounge and slap his skin with the 
back of a broad brush or with a slipper. This is 
all the rousing that is necessary, so long as the 
breathing keops above ten to the minute. Should 
it fall below this, or if the breathing should cease, 
artificial respiration should be employed. (See 
pages 12 and 13.) 

Chloral is a damp, colorless, crystalline sub- 
stance, usually seen in solution. Its symptoms 
and treatment are the same as those of opium. 

IX. Strychnia is an intensely bitter, white 



62 WHAT TO DO FIRST, 

powder. It produces stiffness of the jaws, then 
of the limbs and body. It should be treated by 
provoking vomiting, giving a purge, and doses of 
thirty grains of bromide of potash, or twenty 
grains of chloral, or both to an adult. The 
greatest quiet must be secured. The poisoned 
person should be put to bed in a darkened room, 
with doors, windows and shutters arranged in a 
way that shall exclude all sights, sounds and 
draughts, though permitting good ventilation. 

X. Aconite is sometimes contained in lini- 
ments, and swallowed by mistake. In such a case 
vomiting must be brought on, and followed by the 
administration of stimulants. Strong coffee may 
be used, hartshorn (a teaspoonful in a teacupful of 
water), wine, whisky, or brandy, The patient 
will often feel a peculiar numbness or tingling in 
the arms or legs, which is an evidence that the 
poison has entered the blood, and makes the at- 
tention of a physician imperative. If there is 
depression, warmth should be used, as described 
when speaking of unknown poisons. 

XI. Lunar caustic is sometimes swallowed. 
The antidote of this is a very strong brine of salt 
and water, given again and again ; and vomiting 



IN ACCIDENTS OR POISONING. 63 

should be provoked, until the vomited matters 
cease to have a look like thin milk. 

XII. Alcoholic liquors are sometimes taken in 
such large quantities as to be poisonous. When 
this is the case there are evidences of deep stupor 
or depression. The course to be pursued is to 
cause vomiting, give hartshorn and water (a tea- 
spoonful in a teacupful), and keep the body warm. 
(See page 23. Intoxication.} 

XIII. Hemlock , deadly nightshade, the James- 
town (or jimson) weed, monkshood and toadstools 
are sometimes eaten, without knowledge of their 
poisonous character. Tobacco, too, sometimes 
causes poisonous effects. All produce deep de- 
pression, and must be treated with vomiting, 
followed by stimulation and warmth, very much 
as in the case of aconite poisoning. 

XIV. Decayed meats or vegetables usually ex- 
cite vomiting, which should be encouraged till 
the stomach is empty, and followed by a dose of 
castor oil and some powdered charcoal. 

To save time in an emergency, the following 
table may be consulted ; for the details of treat- 
ment reference may be made to the sections 
indicated by the numbers. 



64 



WHAT TO DO FIRST. 



TREATMENT. 



i. Unknown. 

2. Acids — 

Sulphuric, 
Nitric, 
Muriatic, 
Oxalic. 

3. Alkalies — 

Hartshorn, 
Soda, 
Potash, 
Lye. 

4. Arsenic — 

Paris green, 
Scheele's gr'n 




5. Sugar of Lead. 



6. Corrosive Sublimate, 
Tartar Emetic. 



7. Phosphorus. 



8. Opium — 
Laudanum, 
Paregoric, etc. 
Chloral. 



9. Strychnia. 



10. Aconite 

11. Lunar Caustic 

(Nitrate of Silver). 

12. Alcohol 



13. Jamestown Weed, "] 

Hemlock, 
Nightshade (bella 

donna), 
Toadstool, 
Tobacco. 

14. Decayed Meat or 

Vegetables. 



f Provoke repeated vomiting ; 
-<j Give bland liquids ; 

Stimulate, if necessary. 

Give an alkali ; 

Provoke vomiting ; 

Give bland fluids ; 

Secure rest ; 

Stimulate, if necessary. 
' Give an acid (vinegar) ; 

Provoke vomiting ; 

Give bland liquids ; 

Secure rest ; 

Stimulate, if necessary. 

Provoke vomiting;* 

Give dialysed iron and salt ;* 

Give a dose of castor oil ; 

Secure rest ; 

Stimulate, if necessary. 
[ Give Epsom salts ;* 
J Provoke vomiting ;* 

Give bland liquids ; 

Give dose of castor oil. 

Provoke vomiting ;* 

Give strong tea, without milk ;* 

Give raw eggs and milk ; 

Give dose of castor oil; 

Stimulate, if necessary. 

'Provoke vomiting; 
< Give five-grain doses of sulphate of copper 
(Give dose of magnesia, but no oil. 

(.Provoke vomiting, repeatedly ; 
-< Give strong coffee, without milk ; 
(Keep up the breathing. 

Provoke vomiting, once or twice ; 

Give a purgative ; 

Secure absolute quiet. 

Provoke vomiting ; 

Stimulate well. 

Give strong salt and water ; f 

Provoke vomiting. f 

Provoke vomiting ; 

Give hartshorn and water. 



f Provoke vomiting; 
1 Stimulate well. 



( Provoke vomiting; 
, < Give a purgative ; 
(Give powdered charcoal. 



* Repeat several times, f Repeat many time;.-. 



INDEX 



PAGE 

Abdomen, wounds of 44 

Accidents, railroad and machinery , 53 

Acids, as antidotes 59 

burns with 28 

poisoning by 57, 58 

Aconite 62 

Alcohol, as apoison 63 

Alkalies, as antidotes 57 

as poisons 58, 59 

burns with „ 28 

Ammonia, as an antidote 57 

as a poison 58 

as a stimulant 62,63 

Apoplexy 23 

Arsenic 59 

Arteries, wounds of 46-49 

" inarm 46-48 

" in foot 48 

" in hand 46 

in leg 48 

" inthigh 48 

Back, broken 36 

Bites, of cats 41 

of dogs 41-43 

of snakes 40 

Black-drop 60 

Bland fluids , 56 

Bleeding. (See Hemorrhage.) 

Bones, injuries of 30-36 

Bruises 37 

Burns 26-28 

Carbolic acid 28, 58 

Carron oil 27 

Catalepsy 24 

Cat bite 41 

Caustic, burns with 28 

poisoning with 57>62 

Chloral 61 



IV INDEX. 

PAGE 

Choking , 1 6-18 

Cleansing wounds 44 

Cold and heat, effects of 2 5~ 2 9 

Collar bone, fracture of 35 

Contusions 37 

Convulsions 22 

Corrosive subli mate , 60 

Cuts 43-49 

Decayed meats or vegetables 63 

Depression 56 

Dislocation 3 l ~33 

Dog bites 41 

Drowning 11 

Ear, foreign bodies in 19 

Emetics 55 

Epilepsy 21 

Eye, black 37 

lime in 28 

splinters in 39 

Fainting 20 

Fits 20-24 

Foreign bodies, in ear 19 

in mouth 17 

in nose 19 

in throat 17 

in windpipe 17 

Fractures 33-36 

Freezing 25 

Glass, splinters of 39 

Gunshot wounds 51 

Hanging 15 

Hartshorn. (See Ammonia.) 

Hemlock 63 

Hemorrhage 45-5 1 

capillary 45 

internal 5 1 

from lungs 50 

from nose 5° 

from stomach 50 

Hooks, fish 39 



INDEX. y 

PAGE 

Hydrophobia 4 I_ 43 

Hysterics 21 

Insects, in nose or ear 19 

stings of 41 

Intoxication 23, 63 

Jamestown weed 63 

Jaw, dislocation of 31 

fracture of 36 

Joints, injuriesof 30, 31 

Laudanum 60 

Lead, sugar of 60 

Lime, in eye 28 

Liniments containing poison 58, 62 

Litters for injured persons 54 

Lungs, hemorrhage from 50 

Lye 58 

Machinery accidents 53 

Meats, decayed 63 

Monkshood 63 

Muriaticacid , 28, 57 

Needles, wounds with 38 

Nitric acid 28, 57 

Nose, bleeding from 50 

foreign bodies in 19 

Oil of vitriol. (See Sulphuric Acid.) 

Opium 60, 61 

Oxalic acid 57 

Paregoric 60 

Paris green 59 

Phosphorus 60 

Pin wounds 17, 38 

Poisons 5 5-64 

table for treatment 64 

Potash 58 

Railroad accident injuries 53 

Respiration, artificial 12, 13 

Resuscitation, from drowning 11 

from opium stupor 61 

Ribs, fracture of 35 



VI INDEX. 

PAGE 

Scalds 26-28 

Shock. (See Depression.) 

Silver, nitrate of 62 

Skull, fracture of 36 

Snake bites 40 

Soda 27, 58 

Spanish- windlass 47 

Spinal column, fractures of 36 

Splinters 39, 40 

Splints 34 

Sprains 30 

Stimulation 14,15,25,26,56,61, 62 

Stings of insects 41 

of snakes 40 

Stomach, hemorrhage from 50 

Strangling 16 

Stunning 24 

Strychnia 61 

Suffocation 18 

Sugar of lead 60 

Sulphuric acid 28, 57 

Sunstroke 28 

Tartar emetic 60 

Thorns 39 

Toadstools 63 

Tobacco 63 

Transportation of the injured 53 

Vegetables, decayed 63 

Veins, wounds of 45 

Vitriol, oil of 28, 57 

Vomiting, to allay 56 

to produce , 55 

Washing wounds 44 

Wounds 37—52 

cleansing of 44 

contused 37 

gunshot 51 

incised 43 

lacerated ., ^8 

poisoned 40 

punctured 2^ 



